Bullet embolism is a potential complication of a gunshot wound, especially with a low-velocity missile.This is because the trajectory of the low-velocity bullet can be significantly slowed as it passesthrough tissue. An unusual form of travel can occur in which the bullet enters the vasculature butdoes not have enough kinetic energy to create a through-and-through wound, leading it to remaininside the vasculature. Once inside the vasculature, the bullet could migrate to different parts of thebody, potentially causing complications such as ischemia, becoming a source of thromboembolism,or functioning as a nidus for infection. The management of a bullet embolism varies from case tocase, as each patient with this issue has a unique body habitus that can result in infinite possibilitiesof the trajectory and destination of the bullet embolus. Additional damage to surrounding vasculatureor tissue can occur, as well as embolization of the bullet to critical areas of the body. Here wepresent the case of a 72-year-old man who had a self-inflicted gunshot wound to the chest with alow-velocity bullet, which penetrated the right atrium of the heart. It traveled into the venous vasculaturethrough the right atrium, into the inferior vena cava, and eventually settled in the right internaliliac vein. He refused further intervention and management after initial workup and resuscitation.

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with significant morbidity and mortality. Catheter ablation of AF has been shown to result in a significant reduction in AF burden and recurrence. Pulsed field ablation (PFA) is a new modality of catheter ablation that is noninferior to its thermal ablation counterparts, coupled with a more favorable safety profile. This study seeks to compare clinical outcomes between two PFA systems: PulseSelect™ (Medtronic, Minneapolis, MN, USA) (circular catheter) and FARAPULSE™ (Boston Scientific, Marlborough, MA, USA) (pentaspline catheter). Secondary aims are to evaluate the impacts of post-ablation mapping with a high-density mapping catheter (PAHDMC) and both procedure and fluoroscopy times on recurrence. Overall, across 895 patients with a median follow-up of 12.5 months, there was a recurrence rate of 39%. PFA system, PAHDMC, and procedure time all had no effect on recurrence. To our knowledge, this is the first study to compare recurrence rates between different PFA systems. Fluoroscopy time, however, was a significant predictor of recurrence. In the pentaspline catheter group, the odds of recurrence were 60% greater for every 15 min increase in fluoroscopy time. Future studies are needed to continue comparing outcomes amongst PFA systems and assess whether PAHDMC improves outcomes in PFAs.